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Triage, Not Planning, at Island Hospital

The wreckage now includes one chief executive officer, two good
doctors and a dozen Nightingales.

When Kevin Burchill announced last week that he would resign as CEO
at the Martha's Vineyard Hospital, the crowd absorbed the news in
stunned silence. Hospital trustees assured the public that they support
Mr. Burchill, but the spoken words stood in sharp contrast to the
seating arrangement: After his announcement, Mr. Burchill did not sit at
the table on the stage in the front of the room with the board of
trustees, but instead took a place at the back of the Tisbury School
gymnasium.

The unspoken words hung in the air: How is it possible that the
hospital is in disarray again? And what is the board's
responsibility in all of this?

On Saturday a grim-faced board of trustees couched their explanation
to the community in a lot of finger-pointing. They said it was not easy.
They said they were misunderstood. They said they were working hard.
They said it was complicated. They blamed the press.

Leadership, vision and good communication: The words were all there,
but for hospital trustees on Saturday they were like wisps of smoke
floating in the air - visible, but too elusive to grasp.

Nowhere was this more evident last week than in the simple oral
report from Tim Prince, the health care consultant who was hired last
year to give an assist to the hospital strategic plan.

He said the hospital has relationship problems, problems with trust,
problems with its own community. These problems, Mr. Prince said, are a
roadblock to any good strategic plan.

"Intra-medical staff relationships and the medical
staff-to-administration relationships are contentious and pose a
significant barrier to the pursuit of any strategic initiatives,"
Mr. Prince wrote in his written report.

"Mistrust and skepticism run deep and will need to be overcome
with perseverance and openness," he also wrote.

Dr. Greg Culley, a hospital trustee who heads the strategic planning
committee at the hospital, said the strategic plan is still in its
infancy. "We've only just started," he said.

In truth, the strategic plan at the hospital has been in the works
for more than four years, and it has hardly followed a straight line
unless you count the money thrown at consultants along the way. The
early abstracts for the plan were developed when the hospital was still
in bankruptcy and under the leadership of an emergency board of
trustees.

Ironically, during that period - arguably the hospital's
darkest hour - public confidence in the institution was higher
than it had ever been. After they turned around the crisis, eliminated
the crippling debt and put the hospital on stable financial footing, the
emergency board immediately set its sights on a long-range plan. At the
center of that plan was a new hospital to replace the decaying physical
plant, and a capital campaign to pay for it. Money was also needed to
replenish the endowment fund. The outlook was good, and the hospital was
operating in the black for the first time in memory. The board made a
pledge to the community to keep it that way.

Today among hospital leaders, a sort of selective amnesia prevails
about the work of the emergency board, and the simple goals of the early
strategic plan have been lost in self-important rhetoric and
finger-pointing. Hospital trustees have zigged and zagged their way
across the last four years, accumulating fresh debt, convincing the
taxpayers to contribute $500,000 for the hospital, holding a few
fund-raising events and putting out an annual appeal, but all the work
has been accompanied by a short-term view. Fund-raising dollars are used
to offset operating losses, and the long-range plan and capital campaign
are not even subjects for discussion anymore.

"You don't have enough women on the board,"
declared another resident. The remark touched directly on the real
Achilles' heel of this board, which has never completely recovered
from the resignations of seven trustees three years ago, amid sharp
differences over leadership and judgment. Five of the trustees who
resigned were women, and all of them were known as thoughtful, talented
people with strong leadership qualities and broad backgrounds in
business, fundraising and legal affairs. The women were a key component
of the newly constituted board of trustees that had succeeded the
emergency board. They were directly connected to large donors and were
expected to help launch a solid development plan for the hospital.

The women have all since moved on to play influential roles in other
charities, both on and off the Vineyard.

Today there are only two women on the board, one of them a
representative of the medical staff. The hospital has a development
director who is so far below the radar screen few people even know who
he is. Ditto for most of the trustees.

The conflict between Mr. Burchill and Dr. Richard Koehler is now
over, but the damage has been done. Mr. Burchill will leave the
hospital, and so will Dr. Koehler and his wife, Dr. Kathleen Koehler.
The Nightingales will not do any more gala fund-raising events.

And still the question hangs in the air: What role does the board
play in all of this?

More than one member of the Vineyard community left the forum last
weekend with a heavy heart. Roger Wey, an Oak Bluffs selectman who has
followed hospital affairs for years, was sharply critical. "I am
so disgusted with this board - we have got to stop this revolving
door; we are losing two great doctors and one great CEO," Mr. Wey
said. He continued:

"There is a problem, and this board is like an ostrich with
its head in the sand. This is the good old board again -
it's never them, they always sit in the background while everyone
else gets into a crisis. All of a sudden the plug is pulled and we have
to go back to the dark ages. I think they should dissolve this
board."